Abstract: Arteritic anterior ischaemic optic neuropathy (A-AION) is a sight-threatening condition associated with giant cell arteritis (GCA), a systemic vasculitis affecting medium and large arteries. This article provides a comprehensive review of A-AION and GCA, exploring their pathophysiology, clinical features, diagnostic modalities, management strategies, and recent innovations. By enhancing our understanding of A-AION and GCA, ophthalmologists can improve diagnostic accuracy and optimize management approaches for better patient outcomes.

Introduction: Arteritic A-AION represents a critical ophthalmologic emergency, often occurring in the setting of systemic GCA. Recognizing the association between A-AION and GCA is paramount for prompt diagnosis and appropriate management to prevent vision loss and systemic complications.

Pathophysiology: A-AION results from inflammatory vasculitis affecting the posterior ciliary arteries, leading to ischemic damage to the optic nerve head. GCA is characterized by granulomatous inflammation of medium and large arteries, including the temporal arteries supplying the optic nerve.

Clinical Manifestations: Patients with A-AION typically present with acute, painless vision loss, often accompanied by systemic symptoms of GCA, such as headache, jaw claudication, and constitutional symptoms. Ophthalmic examination may reveal optic disc edema, segmental disc pallor, and visual field defects consistent with optic nerve ischemia.

Diagnostic Modalities: Diagnosis of A-AION and GCA involves a multidisciplinary approach, including ophthalmic evaluation, laboratory testing, imaging studies, and temporal artery biopsy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and temporal artery ultrasound are valuable tools for assessing disease activity and guiding treatment decisions.

Management Strategies: Management of A-AION and GCA aims to prevent vision loss, alleviate symptoms, and reduce systemic complications. Treatment modalities may include high-dose corticosteroids to suppress inflammation, immunosuppressive agents for steroid-sparing therapy, and antiplatelet or anticoagulant therapy for thromboembolic prophylaxis.

Recent Advances: Recent advancements in A-AION and GCA research focus on improving diagnostic accuracy, optimizing treatment regimens, and exploring novel therapeutic targets. Innovations such as advanced imaging techniques, biomarker analysis, and targeted immunomodulatory therapies offer promising avenues for enhancing patient outcomes and minimizing treatment-related complications.

Conclusion: Arteritic A-AION associated with GCA poses significant challenges in ophthalmology and rheumatology, requiring prompt recognition and aggressive management. By staying informed about the latest research and innovations in A-AION and GCA, ophthalmologists can collaborate effectively with other specialists to provide comprehensive care, ultimately improving visual outcomes and quality of life for patients.

For further reading and reference:

• American College of Rheumatology – Giant Cell Arteritis: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Giant-Cell-Arteritis
• National Eye Institute – Facts About Giant Cell Arteritis: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/giant-cell-arteritis
• Journal of Neuro-Ophthalmology – Arteritic Anterior Ischemic Optic Neuropathy: https://journals.lww.com/jneuro-ophthalmology/pages/default.aspx